Post-operative Pain Clinical Trial
Official title:
Intracanalicular Dexamethasone Insert for Management of Post-operative Pain and Inflammation in Patients Undergoing Vitreoretinal Surgery
Verified date | January 2023 |
Source | The Cleveland Clinic |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study will assess the control of inflammation at days 1, 7, 14, and 21 days following the vitreoretinal surgical procedure analyzing two randomized study arms: Intracanalicular dexamethasone insert group or topical steroid drop group. Patients must be 18 years of age and older, of any race and either sex, requiring surgery with the procedure type of pars plana vitrectomy for either the indication of macular hole, epiretinal membrane removal, or vitreomacular traction.
Status | Enrolling by invitation |
Enrollment | 30 |
Est. completion date | June 1, 2024 |
Est. primary completion date | December 1, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Men and women >18 years old - Planning to undergo vitreoretinal surgery with the procedure type of pars plana vitrectomy for either the indication of macular hole, epiretinal membrane removal, or vitreomacular traction. Exclusion Criteria: - Patients undergoing combined cataract or glaucoma procedure, intraocular lens exchange, scleral buckle, and/or implant of a drug delivery system - History of complications, trauma, adverse events, disease in nasolacrimal region, including dacryocystitis, canaliculitis in either eye - Structural lid abnormalities such as ectropion or entropion in surgical eye - Ongoing use of systemic narcotic pain relievers - Presence of any intraocular inflammation (cells and flare) in the study eye at screening/baseline - Pain score greater than "0" on the ocular pain assessment in the study eye at screening/baseline - Active or chronic or recurrent uncontrolled ocular or systemic inflammatory disease, including diabetes - Other ocular surgeries or procedures during the study period and/or 6 months prior - Intraoperative complications - Patients with history of glaucoma (defined as glaucoma requiring 2 or more drops, IOP at baseline greater than 25, or advanced optic nerve cupping). Patients with glaucoma or ocular hypertension controlled with a single drop can be enrolled. - Patients with a known hypersensitivity to NSAIDs or steroids or any component of the study medication. - Have used ocular, topical, or systemic NSAIDs within 7 days prior to procedure and during surgery. - Use of intracameral or subconjunctival NSAIDs or steroids intraoperatively. - Have used topical, ocular, inhaled or systemic steroids within 14 days prior to procedure - Are pregnant or nursing/lactating - Participation as a subject in any clinical study within the 30 days prior to randomization. - Surgeries using 20 gauge or 23 gauge instruments. |
Country | Name | City | State |
---|---|---|---|
United States | Cole Eye Institute, Cleveland Clinic | Cleveland | Ohio |
Lead Sponsor | Collaborator |
---|---|
The Cleveland Clinic | Ocular Therapeutix, Inc. |
United States,
An JA, Kasner O, Samek DA, Levesque V. Evaluation of eyedrop administration by inexperienced patients after cataract surgery. J Cataract Refract Surg. 2014 Nov;40(11):1857-61. doi: 10.1016/j.jcrs.2014.02.037. Epub 2014 Sep 22. — View Citation
Gira JP, Sampson R, Silverstein SM, Walters TR, Metzinger JL, Talamo JH. Evaluating the patient experience after implantation of a 0.4 mg sustained release dexamethasone intracanalicular insert (Dextenza): results of a qualitative survey. Patient Prefer Adherence. 2017 Mar 8;11:487-494. doi: 10.2147/PPA.S126283. eCollection 2017. — View Citation
Hermann MM, Ustundag C, Diestelhorst M. Electronic compliance monitoring of topical treatment after ophthalmic surgery. Int Ophthalmol. 2010 Aug;30(4):385-90. doi: 10.1007/s10792-010-9362-3. Epub 2010 Apr 7. — View Citation
Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep;140(3):509-16. doi: 10.1016/j.ajo.2005.03.057. — View Citation
Tyson SL, Bafna S, Gira JP, Goldberg DF, Jones JJ, Jones MP, Kim JK, Martel JM, Nordlund ML, Piovanetti-Perez IK, Singh IP, Metzinger JL, Mulani D, Sane S, Talamo JH, Goldstein MH; Dextenza Study Group. Multicenter randomized phase 3 study of a sustained-release intracanalicular dexamethasone insert for treatment of ocular inflammation and pain after cataract surgery. J Cataract Refract Surg. 2019 Feb;45(2):204-212. doi: 10.1016/j.jcrs.2018.09.023. Epub 2018 Oct 24. Erratum In: J Cataract Refract Surg. 2019 Jun;45(6):895. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | To assess control of inflammation following the vitreoretinal surgical procedure. | Percentage of patients with Inflammation following surgery as assessed from 0-4+ cell and flare based on the Standardization of Uveitis Nomenclature [SUN] Working Group grading scheme at day 14 | day 14 following surgery | |
Secondary | The patient reporting of pain following surgery using visual analog pain scale at days 1, 3, 7, 14, and 21 following surgery. | Pain following surgery will be measured using a scale from 0 to10 (0 = no pain, 10 = severe pain that prevents performing activities of daily living). Higher scores mean a worse outcome. | days 1, 3, 7, 14, and 21 following surgery | |
Secondary | Inflammation assessed on Anterior Segment OCT by masked grading at days 1, 7, 14, and 21 following surgery. | Anterior segment will be assessed using a continuous variable (cells/mm3). | days 1, 7, 14, and 21 following surgery | |
Secondary | Mean change in Best Corrected Visual Acuity (BCVA) from baseline to day 21 following surgery. | BCVA was assessed by Early Treatment of Diabetic Retinopathy Study (ETDRS) method. | day 21 following surgery | |
Secondary | % of patients with rebound inflammation defined as a two-step worsening of inflammation by SUN grading. | day 21 following surgery | ||
Secondary | % of patients receiving rescue treatment. | days 1, 7, 14, and 21 following surgery | ||
Secondary | % of patients with postoperative management via telephone or electronic messaging | day 21 following surgery | ||
Secondary | The incidence and severity of ocular and non-ocular adverse events (AEs) and serious AEs between arms. | day 21 following surgery |
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